|
HC MR CHEST WO CON
|
Facility
|
IP
|
$2,032.25
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,320.96 |
| Max. Negotiated Rate |
$2,032.25 |
| Rate for Payer: Aetna Commercial |
$1,829.02
|
| Rate for Payer: ASR ASR |
$1,971.28
|
| Rate for Payer: ASR Commercial |
$1,971.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.08
|
| Rate for Payer: BCN Commercial |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,910.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Healthscope Commercial |
$2,032.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.28
|
| Rate for Payer: Mclaren Commercial |
$1,829.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.41
|
| Rate for Payer: Nomi Health Commercial |
$1,666.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.38
|
|
|
HC MR CHEST WO CON
|
Facility
|
OP
|
$2,032.25
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,032.25 |
| Rate for Payer: Aetna Commercial |
$1,829.02
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,971.28
|
| Rate for Payer: ASR Commercial |
$1,971.28
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.21
|
| Rate for Payer: BCN Commercial |
$1,575.60
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,910.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,032.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,829.02
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.41
|
| Rate for Payer: Nomi Health Commercial |
$1,666.44
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,576.74
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,261.39
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CHEST WO W CON
|
Facility
|
OP
|
$3,052.80
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,747.52
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,961.22
|
| Rate for Payer: ASR Commercial |
$2,961.22
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.94
|
| Rate for Payer: BCN Commercial |
$2,366.84
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,869.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$3,052.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,961.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,747.52
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: Nomi Health Commercial |
$2,503.30
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,077.98
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,662.38
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR CHEST WO W CON
|
Facility
|
IP
|
$3,052.80
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,984.32 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,747.52
|
| Rate for Payer: ASR ASR |
$2,961.22
|
| Rate for Payer: ASR Commercial |
$2,961.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,487.73
|
| Rate for Payer: BCN Commercial |
$2,366.84
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,869.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Healthscope Commercial |
$3,052.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,961.22
|
| Rate for Payer: Mclaren Commercial |
$2,747.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: Nomi Health Commercial |
$2,503.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.46
|
|
|
HC MR ELASTOGRAPHY
|
Facility
|
IP
|
$359.98
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$233.99 |
| Max. Negotiated Rate |
$359.98 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: ASR ASR |
$349.18
|
| Rate for Payer: ASR Commercial |
$349.18
|
| Rate for Payer: BCBS Trust/PPO |
$293.35
|
| Rate for Payer: BCN Commercial |
$279.09
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$338.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Healthscope Commercial |
$359.98
|
| Rate for Payer: Healthscope Whirlpool |
$349.18
|
| Rate for Payer: Mclaren Commercial |
$323.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.98
|
| Rate for Payer: Nomi Health Commercial |
$295.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.78
|
|
|
HC MR ELASTOGRAPHY
|
Facility
|
OP
|
$359.98
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$367.09 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$349.18
|
| Rate for Payer: ASR Commercial |
$349.18
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$294.79
|
| Rate for Payer: BCN Commercial |
$279.09
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$338.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$359.98
|
| Rate for Payer: Healthscope Whirlpool |
$349.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$323.98
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.98
|
| Rate for Payer: Nomi Health Commercial |
$295.18
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.97
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$211.18
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR GUIDANCE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,045.60
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$679.64 |
| Max. Negotiated Rate |
$1,045.60 |
| Rate for Payer: Aetna Commercial |
$941.04
|
| Rate for Payer: ASR ASR |
$1,014.23
|
| Rate for Payer: ASR Commercial |
$1,014.23
|
| Rate for Payer: BCBS Trust/PPO |
$852.06
|
| Rate for Payer: BCN Commercial |
$810.65
|
| Rate for Payer: Cash Price |
$836.48
|
| Rate for Payer: Cofinity Commercial |
$982.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.48
|
| Rate for Payer: Healthscope Commercial |
$1,045.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,014.23
|
| Rate for Payer: Mclaren Commercial |
$941.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.76
|
| Rate for Payer: Nomi Health Commercial |
$857.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$920.13
|
|
|
HC MR GUIDANCE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,045.60
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$418.24 |
| Max. Negotiated Rate |
$1,045.60 |
| Rate for Payer: Aetna Commercial |
$941.04
|
| Rate for Payer: Aetna Medicare |
$522.80
|
| Rate for Payer: ASR ASR |
$1,014.23
|
| Rate for Payer: ASR Commercial |
$1,014.23
|
| Rate for Payer: BCBS Complete |
$418.24
|
| Rate for Payer: BCBS Trust/PPO |
$856.24
|
| Rate for Payer: BCN Commercial |
$810.65
|
| Rate for Payer: Cash Price |
$836.48
|
| Rate for Payer: Cofinity Commercial |
$982.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.48
|
| Rate for Payer: Healthscope Commercial |
$1,045.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,014.23
|
| Rate for Payer: Mclaren Commercial |
$941.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.76
|
| Rate for Payer: Nomi Health Commercial |
$857.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.15
|
| Rate for Payer: Priority Health Narrow Network |
$732.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$920.13
|
|
|
HC MR LOWER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
IP
|
$3,014.98
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
61000040
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,959.74 |
| Max. Negotiated Rate |
$3,014.98 |
| Rate for Payer: Aetna Commercial |
$2,713.48
|
| Rate for Payer: ASR ASR |
$2,924.53
|
| Rate for Payer: ASR Commercial |
$2,924.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,456.91
|
| Rate for Payer: BCN Commercial |
$2,337.51
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cofinity Commercial |
$2,834.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,411.98
|
| Rate for Payer: Healthscope Commercial |
$3,014.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,924.53
|
| Rate for Payer: Mclaren Commercial |
$2,713.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,562.73
|
| Rate for Payer: Nomi Health Commercial |
$2,472.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,959.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,653.18
|
|
|
HC MR LOWER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
OP
|
$3,014.98
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
61000040
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$3,014.98 |
| Rate for Payer: Aetna Commercial |
$2,713.48
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,924.53
|
| Rate for Payer: ASR Commercial |
$2,924.53
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,468.97
|
| Rate for Payer: BCN Commercial |
$2,337.51
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cofinity Commercial |
$2,834.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,411.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$3,014.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,924.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,713.48
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,562.73
|
| Rate for Payer: Nomi Health Commercial |
$2,472.28
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,959.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,967.09
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,573.67
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,653.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR LOWER EXTREM ANY JOINT W CON
|
Facility
|
IP
|
$2,252.06
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,463.84 |
| Max. Negotiated Rate |
$2,252.06 |
| Rate for Payer: Aetna Commercial |
$2,026.85
|
| Rate for Payer: Aetna Commercial |
$3,040.28
|
| Rate for Payer: ASR ASR |
$3,276.75
|
| Rate for Payer: ASR ASR |
$2,184.50
|
| Rate for Payer: ASR Commercial |
$3,276.75
|
| Rate for Payer: ASR Commercial |
$2,184.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,752.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,835.20
|
| Rate for Payer: BCN Commercial |
$2,619.03
|
| Rate for Payer: BCN Commercial |
$1,746.02
|
| Rate for Payer: Cash Price |
$1,801.65
|
| Rate for Payer: Cash Price |
$2,702.47
|
| Rate for Payer: Cofinity Commercial |
$3,175.40
|
| Rate for Payer: Cofinity Commercial |
$2,116.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,801.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.47
|
| Rate for Payer: Healthscope Commercial |
$2,252.06
|
| Rate for Payer: Healthscope Commercial |
$3,378.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,276.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,184.50
|
| Rate for Payer: Mclaren Commercial |
$2,026.85
|
| Rate for Payer: Mclaren Commercial |
$3,040.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,914.25
|
| Rate for Payer: Nomi Health Commercial |
$2,770.03
|
| Rate for Payer: Nomi Health Commercial |
$1,846.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,981.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,972.72
|
|
|
HC MR LOWER EXTREM ANY JOINT W CON
|
Facility
|
OP
|
$3,378.09
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$3,378.09 |
| Rate for Payer: Aetna Commercial |
$3,040.28
|
| Rate for Payer: Aetna Commercial |
$2,026.85
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$3,276.75
|
| Rate for Payer: ASR ASR |
$2,184.50
|
| Rate for Payer: ASR Commercial |
$2,184.50
|
| Rate for Payer: ASR Commercial |
$3,276.75
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,766.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,844.21
|
| Rate for Payer: BCN Commercial |
$1,746.02
|
| Rate for Payer: BCN Commercial |
$2,619.03
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$2,702.47
|
| Rate for Payer: Cash Price |
$1,801.65
|
| Rate for Payer: Cash Price |
$2,702.47
|
| Rate for Payer: Cash Price |
$1,801.65
|
| Rate for Payer: Cofinity Commercial |
$2,116.94
|
| Rate for Payer: Cofinity Commercial |
$3,175.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,801.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$2,252.06
|
| Rate for Payer: Healthscope Commercial |
$3,378.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,184.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,276.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$2,026.85
|
| Rate for Payer: Mclaren Commercial |
$3,040.28
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,914.25
|
| Rate for Payer: Nomi Health Commercial |
$2,770.03
|
| Rate for Payer: Nomi Health Commercial |
$1,846.69
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,693.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,693.14
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.51
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,981.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,972.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC MR LOWER EXTREM ANY JOINT WO CON
|
Facility
|
OP
|
$2,899.35
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,899.35 |
| Rate for Payer: Aetna Commercial |
$2,609.42
|
| Rate for Payer: Aetna Commercial |
$1,739.61
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$2,812.37
|
| Rate for Payer: ASR ASR |
$1,874.91
|
| Rate for Payer: ASR Commercial |
$1,874.91
|
| Rate for Payer: ASR Commercial |
$2,812.37
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,374.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.85
|
| Rate for Payer: BCN Commercial |
$1,498.58
|
| Rate for Payer: BCN Commercial |
$2,247.87
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$2,319.48
|
| Rate for Payer: Cash Price |
$1,546.32
|
| Rate for Payer: Cash Price |
$2,319.48
|
| Rate for Payer: Cash Price |
$1,546.32
|
| Rate for Payer: Cofinity Commercial |
$1,816.93
|
| Rate for Payer: Cofinity Commercial |
$2,725.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,319.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,546.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,932.90
|
| Rate for Payer: Healthscope Commercial |
$2,899.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,874.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,812.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,739.61
|
| Rate for Payer: Mclaren Commercial |
$2,609.42
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,464.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.96
|
| Rate for Payer: Nomi Health Commercial |
$2,377.47
|
| Rate for Payer: Nomi Health Commercial |
$1,584.98
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,884.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.88
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,334.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,334.30
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,700.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,551.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR LOWER EXTREM ANY JOINT WO CON
|
Facility
|
IP
|
$1,932.90
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,256.38 |
| Max. Negotiated Rate |
$1,932.90 |
| Rate for Payer: Aetna Commercial |
$1,739.61
|
| Rate for Payer: Aetna Commercial |
$2,609.42
|
| Rate for Payer: ASR ASR |
$2,812.37
|
| Rate for Payer: ASR ASR |
$1,874.91
|
| Rate for Payer: ASR Commercial |
$2,812.37
|
| Rate for Payer: ASR Commercial |
$1,874.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,362.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.12
|
| Rate for Payer: BCN Commercial |
$2,247.87
|
| Rate for Payer: BCN Commercial |
$1,498.58
|
| Rate for Payer: Cash Price |
$1,546.32
|
| Rate for Payer: Cash Price |
$2,319.48
|
| Rate for Payer: Cofinity Commercial |
$2,725.39
|
| Rate for Payer: Cofinity Commercial |
$1,816.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,319.48
|
| Rate for Payer: Healthscope Commercial |
$1,932.90
|
| Rate for Payer: Healthscope Commercial |
$2,899.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,812.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,874.91
|
| Rate for Payer: Mclaren Commercial |
$1,739.61
|
| Rate for Payer: Mclaren Commercial |
$2,609.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,464.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.96
|
| Rate for Payer: Nomi Health Commercial |
$2,377.47
|
| Rate for Payer: Nomi Health Commercial |
$1,584.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,884.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,700.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,551.43
|
|
|
HC MR LOWER EXTREM ANY JOINT WO W CON
|
Facility
|
OP
|
$3,800.36
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$3,800.36 |
| Rate for Payer: Aetna Commercial |
$3,420.32
|
| Rate for Payer: Aetna Commercial |
$2,280.21
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$3,686.35
|
| Rate for Payer: ASR ASR |
$2,457.56
|
| Rate for Payer: ASR Commercial |
$2,457.56
|
| Rate for Payer: ASR Commercial |
$3,686.35
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,112.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.74
|
| Rate for Payer: BCN Commercial |
$1,964.28
|
| Rate for Payer: BCN Commercial |
$2,946.42
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$3,040.29
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cash Price |
$3,040.29
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cofinity Commercial |
$2,381.56
|
| Rate for Payer: Cofinity Commercial |
$3,572.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,040.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,026.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,533.57
|
| Rate for Payer: Healthscope Commercial |
$3,800.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,457.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,686.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,280.21
|
| Rate for Payer: Mclaren Commercial |
$3,420.32
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,153.53
|
| Rate for Payer: Nomi Health Commercial |
$3,116.30
|
| Rate for Payer: Nomi Health Commercial |
$2,077.53
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,470.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,967.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,967.09
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,573.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,573.67
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,229.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,344.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR LOWER EXTREM ANY JOINT WO W CON
|
Facility
|
IP
|
$2,533.57
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,646.82 |
| Max. Negotiated Rate |
$2,533.57 |
| Rate for Payer: Aetna Commercial |
$2,280.21
|
| Rate for Payer: Aetna Commercial |
$3,420.32
|
| Rate for Payer: ASR ASR |
$3,686.35
|
| Rate for Payer: ASR ASR |
$2,457.56
|
| Rate for Payer: ASR Commercial |
$3,686.35
|
| Rate for Payer: ASR Commercial |
$2,457.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,096.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.61
|
| Rate for Payer: BCN Commercial |
$2,946.42
|
| Rate for Payer: BCN Commercial |
$1,964.28
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cash Price |
$3,040.29
|
| Rate for Payer: Cofinity Commercial |
$3,572.34
|
| Rate for Payer: Cofinity Commercial |
$2,381.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,026.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,040.29
|
| Rate for Payer: Healthscope Commercial |
$2,533.57
|
| Rate for Payer: Healthscope Commercial |
$3,800.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,686.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,457.56
|
| Rate for Payer: Mclaren Commercial |
$2,280.21
|
| Rate for Payer: Mclaren Commercial |
$3,420.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,153.53
|
| Rate for Payer: Nomi Health Commercial |
$3,116.30
|
| Rate for Payer: Nomi Health Commercial |
$2,077.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,470.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,229.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,344.32
|
|
|
HC MR LOWER EXTREM BIL ANY JOINT W CON
|
Facility
|
IP
|
$2,392.92
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,392.92 |
| Rate for Payer: Aetna Commercial |
$2,153.63
|
| Rate for Payer: ASR ASR |
$2,321.13
|
| Rate for Payer: ASR Commercial |
$2,321.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.99
|
| Rate for Payer: BCN Commercial |
$1,855.23
|
| Rate for Payer: Cash Price |
$1,914.34
|
| Rate for Payer: Cofinity Commercial |
$2,249.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,914.34
|
| Rate for Payer: Healthscope Commercial |
$2,392.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,321.13
|
| Rate for Payer: Mclaren Commercial |
$2,153.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.98
|
| Rate for Payer: Nomi Health Commercial |
$1,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,555.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,105.77
|
|
|
HC MR LOWER EXTREM BIL ANY JOINT W CON
|
Facility
|
OP
|
$2,392.92
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$2,392.92 |
| Rate for Payer: Aetna Commercial |
$2,153.63
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$2,321.13
|
| Rate for Payer: ASR Commercial |
$2,321.13
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.56
|
| Rate for Payer: BCN Commercial |
$1,855.23
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,914.34
|
| Rate for Payer: Cash Price |
$1,914.34
|
| Rate for Payer: Cofinity Commercial |
$2,249.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,914.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$2,392.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,321.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$2,153.63
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.98
|
| Rate for Payer: Nomi Health Commercial |
$1,962.19
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,555.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,693.14
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.51
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,105.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC MR LOWER EXTREM BILAT ANY JOINT WO CON
|
Facility
|
OP
|
$1,971.56
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,971.56 |
| Rate for Payer: Aetna Commercial |
$1,774.40
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,912.41
|
| Rate for Payer: ASR Commercial |
$1,912.41
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.51
|
| Rate for Payer: BCN Commercial |
$1,528.55
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cofinity Commercial |
$1,853.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,577.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,971.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,912.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,774.40
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,675.83
|
| Rate for Payer: Nomi Health Commercial |
$1,616.68
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.88
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,334.30
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,734.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR LOWER EXTREM BILAT ANY JOINT WO CON
|
Facility
|
IP
|
$1,971.56
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,281.51 |
| Max. Negotiated Rate |
$1,971.56 |
| Rate for Payer: Aetna Commercial |
$1,774.40
|
| Rate for Payer: ASR ASR |
$1,912.41
|
| Rate for Payer: ASR Commercial |
$1,912.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,606.62
|
| Rate for Payer: BCN Commercial |
$1,528.55
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cofinity Commercial |
$1,853.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,577.25
|
| Rate for Payer: Healthscope Commercial |
$1,971.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,912.41
|
| Rate for Payer: Mclaren Commercial |
$1,774.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,675.83
|
| Rate for Payer: Nomi Health Commercial |
$1,616.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,734.97
|
|
|
HC MR LOWER EXTREM BIL NO JOINT W CON
|
Facility
|
IP
|
$2,955.86
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,921.31 |
| Max. Negotiated Rate |
$2,955.86 |
| Rate for Payer: Aetna Commercial |
$2,660.27
|
| Rate for Payer: ASR ASR |
$2,867.18
|
| Rate for Payer: ASR Commercial |
$2,867.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,408.73
|
| Rate for Payer: BCN Commercial |
$2,291.68
|
| Rate for Payer: Cash Price |
$2,364.69
|
| Rate for Payer: Cofinity Commercial |
$2,778.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,364.69
|
| Rate for Payer: Healthscope Commercial |
$2,955.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,867.18
|
| Rate for Payer: Mclaren Commercial |
$2,660.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,512.48
|
| Rate for Payer: Nomi Health Commercial |
$2,423.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,921.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,601.16
|
|
|
HC MR LOWER EXTREM BIL NO JOINT W CON
|
Facility
|
OP
|
$2,955.86
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,955.86 |
| Rate for Payer: Aetna Commercial |
$2,660.27
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,867.18
|
| Rate for Payer: ASR Commercial |
$2,867.18
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,420.55
|
| Rate for Payer: BCN Commercial |
$2,291.68
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,364.69
|
| Rate for Payer: Cash Price |
$2,364.69
|
| Rate for Payer: Cofinity Commercial |
$2,778.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,364.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,955.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,867.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,660.27
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,512.48
|
| Rate for Payer: Nomi Health Commercial |
$2,423.81
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,921.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.07
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,380.86
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,601.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR LOWER EXTREM BIL NO JOINT WO CON
|
Facility
|
OP
|
$2,297.10
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Aetna Commercial |
$2,067.39
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$2,228.19
|
| Rate for Payer: ASR Commercial |
$2,228.19
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.10
|
| Rate for Payer: BCN Commercial |
$1,780.94
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$2,159.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,297.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,228.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$2,067.39
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$1,883.62
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,835.87
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,468.70
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,021.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR LOWER EXTREM BIL NO JOINT WO CON
|
Facility
|
IP
|
$2,297.10
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,493.12 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Aetna Commercial |
$2,067.39
|
| Rate for Payer: ASR ASR |
$2,228.19
|
| Rate for Payer: ASR Commercial |
$2,228.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,871.91
|
| Rate for Payer: BCN Commercial |
$1,780.94
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$2,159.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Healthscope Commercial |
$2,297.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,228.19
|
| Rate for Payer: Mclaren Commercial |
$2,067.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$1,883.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,021.45
|
|
|
HC MR LOWER EXTREM NO JOINT BIL WO W CON
|
Facility
|
IP
|
$3,158.55
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,053.06 |
| Max. Negotiated Rate |
$3,158.55 |
| Rate for Payer: Aetna Commercial |
$2,842.70
|
| Rate for Payer: ASR ASR |
$3,063.79
|
| Rate for Payer: ASR Commercial |
$3,063.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,573.90
|
| Rate for Payer: BCN Commercial |
$2,448.82
|
| Rate for Payer: Cash Price |
$2,526.84
|
| Rate for Payer: Cofinity Commercial |
$2,969.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.84
|
| Rate for Payer: Healthscope Commercial |
$3,158.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,063.79
|
| Rate for Payer: Mclaren Commercial |
$2,842.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.77
|
| Rate for Payer: Nomi Health Commercial |
$2,590.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,779.52
|
|
